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Prevention of Nerve Injury During Arthroscopic Capsulectomy of the Elbow Utilizing a Safety-Driven Strategy

Blonna, Davide MD; Wolf, Jennifer Moriatis MD; Fitzsimmons, James S. BSc; O’Driscoll, Shawn W. MD, PhD, FRCS(C)

Journal of Bone & Joint Surgery - American Volume: 7 August 2013 - Volume 95 - Issue 15 - p 1373–1381
doi: 10.2106/JBJS.K.00972
Scientific Articles
Supplementary Content
Disclosures

Background: A major factor limiting the use of elbow arthroscopy for contracture release is concern regarding nerve injury. The purpose of this report is to document the risk of nerve injury in a large series of arthroscopic contracture releases utilizing a safety-driven strategy.

Methods: A series of 502 arthroscopic elbow contracture releases (including 388 osteocapsular arthroplasties) performed in 464 patients by one surgeon was reviewed retrospectively. The safety-driven step-wise strategy had been carried out in a standardized sequence: (1) Get In and Establish a View, (2) Create a Space in Which to Work, (3) Bone Removal, and (4) Capsulectomy. Neurologic complications were assessed and were followed until resolution.

Results: No patient had a permanent nerve injury. Twenty-four patients (5%) had a transient nerve injury, associated with prolonged tourniquet time, cutaneous dysesthesia attributed to open incisions, simultaneous ulnar nerve transposition, or retractor use. All nerve deficits resolved after one day to twenty-four months, with one patient lost to follow-up.

Conclusions: Utilizing the technique described, arthroscopic contracture release and debridement of the elbow was performed with a low risk of nerve injury.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin 10128, Italy

2New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-4037

3Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905. E-mail address for S.W. O’Driscoll: odriscoll.shawn@mayo.edu

* Davide Blonna, MD, and Jennifer Moriatis Wolf, MD, contributed equally to the preparation of this article.

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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